Provider Financial Responsibility for Pre-Service Review for BlueCard® Members

Policy Number: GP-X-085

Last Updated: Aug. 1, 2022 

Blue Cross and Blue Shield of Nebraska (BCBSNE) participating providers are responsible for obtaining pre-service review for inpatient facility services for BlueCard members and must hold the member harmless when pre-service review is required by the account or member contract and is not completed for inpatient services. Participating providers must also:

  • Notify the member’s Blue Cross Blue Shield Plan within 48 hours when a change or modification to the original pre-service review occurs. 
  • Obtain pre-service review for emergency and/or urgent admissions within 72 hours. 

Pre-service review contact information for a member’s BCBS Plan is provided on the member’s identification card. Pre-service review requirements can also be determined by: 

  • Using the Electronic Provider Access (EPA) tool available from NaviNet®, under Pre-Service Review for Out-of-Area Members
  • Calling 800-676-BLUE (2583). 

Services that deny as not medically necessary remain member liability. 

*Unless the member signed a written consent to be billed prior to rendering the service. 

BlueCard® - registered derivative. NaviNet is a healthcare provider portal providing services for Blue Cross and Blue Shield of Nebraska.